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Common Behavioral and Cognitive Interventions in
Primary CareBased on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance
for Assessment and Intervention Hunter et al, 2009
Presented August 2011 byKatherine M. Dollar, PhD.,
What’s in Your Toolbox?
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The Co-located, Collaborative Provider’s
Toolkit The following 8 techniques are effective for addressing a wide
variety of symptoms and functional impairment seen in primary care (Hunter et al., 2009)
1. Relaxation training 2. Goal setting 3. Identifying and disputing negative cognitions 4. Motivational Interviewing 5. Problem Solving 6. Self-monitoring 7. Behavioral Activation 8. Assertive Communication
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Relaxation Training
Deep Breathing Cue-controlled relaxation Progressive muscle relaxation Visual imagery
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Goal Setting
Are the goals well defined in behavioral terms? (S.M.A.R.T)
Realistic/achievable With in realm of control/influence Break into sub goals Personally important Whose goals are they anyway?
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Identifying and Disputing Negative Cognitions
Help to indentify unhealthy cognitions (predictions, expectations, evaluations)
Use thought logs Question thought process “Cognitive Disputation” Self-help books for highly motivated
Mind Over Mood: Greenberger and Padesky 6
Motivational Interviewing
Examine readiness to change (Readiness Ruler)
Examine importance and confidence for change
Elicit pros and cons of change
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Problem Solving A five-step problem-solving model is
recommended for the PC setting (Nezu, personal communication, 2011)
1. Minimize emotional arousal to focus on next 4 steps
2. Set an achievable goal, identify major obstacles
3. Brainstorm multiple alternatives to overcoming obstacles
4. Identify pros and cons of each idea, cost-benefit analysis
5. Implement an action plan and assess the outcome (either fine-tune or go back through steps 1-4)
Please note: Additional PST trainings will be available in the future.
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Self-Monitoring
Help track progress towards a goal Use a calendar Keep a tally Chart on a graph
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Behavioral Activation
• Difficult to feel depressed when engaged in actives that provide pleasure and accomplishment
• Re-establish routines • Increase reinforcing experiences• Overcome avoidance patterns• Distraction from problems or unpleasant
events
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Behavioral Activation Techniques
• Choose and schedule daily pleasurable activities (Pleasant Events Schedule or Life Activities Checklist)
• List activities and rate for mastery and pleasure
• Keep activity logs
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Assertive Communication
Assess patterns of communication Explain differences in passive,
assertive, and aggressive communication
Help patient to learn how to speak assertively (Honest, Appropriate, Respectful, Direct)
Practice through role-play The Anxiety and Phobia Workbook 12
Helpful Resources
Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated Behavioral Health in Primary Care: Step-by-step Guidance for Assessment and Intervention, American Psychological Association.
Gatchel, R. J. & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration: Washington, DC; American Psychological Association.
P. Robinson & J. Reiter (2007) Behavioral consultation and primary care: A guide to integrating services. New York: Springer Science-Media.
W. O'Donohoe, M. Byrd, N. Cummings, D. Henderson (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Routledge.
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Questions?
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Helpful IPC Resources
http://vaww.visn2.med.va.gov/bh/cih/index.html
http://vaww4.va.gov/pcmhi/ http://www.cfha.net
E-mail address:[email protected]
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